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In his youth as a student at JJ Hospital, Dr SM Merchant had never ventured into or even heard of Dharavi. He lived in Dongri in those days and Dharavi was just the outskirts of the bustling city. The sexagenarian doctor, who has now been practising in Dharavi for 40 years, says it was happenstance that led him to what was then a marshy patch of land.

The story goes that a compounder told him of a locum clinic that needed a substitute doctor to fill in the hours. “He said he would show me the place, which was in Dharavi, and asked me to meet him outside the Sion railway station at 4 pm,” recalls Dr Merchant. After hours of waiting, the compounder did not turn up and a miffed Merchant went home. A few days later, he heard of another locum clinic in Dharavi and was asked to “sit around and read” there until the regular doctor returned.

“But I found myself very busy with the patients and I picked up pace from the very first day,” says Dr Merchant. The compounder who had stood him up outside Sion station happened to pass by and burst into the clinic, saying, “You are here! This is the clinic that I wanted to show you that day!” Dr Merchant’s clinical wisdom was a great hit in the area and what was a temporary job became a passion. He went on to open his own private practice near Bismillah Hotel, complete with a low ceiling and a table fan chained securely to a post. For Dr Merchant, Dharavi was his destiny.

Dr Merchant now works from his dispensary on 90 Feet Road, opposite the Colour Box. It is a narrow room squeezed between a chai shop and an egg distributor. He is unhappy with the number of egg distributors on 90 Feet Road and their business strategy of selling broken eggs for cheap in plastic pouches. Dr Merchant continuously warns his patients – including his compounder, who buy a broken egg or two now and then – of how unhealthy it is to consume these germ-ridden produce.

With four decades of experience in Dharavi, Dr Merchant says that, while people have more buying power, the overall quality of health has declined and people invest in good health only when most required. The most frequent complaints are common colds and fevers, as well as major illnesses like malaria and typhoid. People with tuberculosis used to knock on his doors quite often, but with the intervention of government hospitals and free medicines they have been diverted to larger centres such as Sion Hospital. Dr Merchant says that the number of consultations for cancer has gone up and that diseases like dengue, unheard of some decades ago, are on the rise. “The major reasons for the decline in health would be population, pollution and space. Real estate is so expensive in Dharavi and you will find entire families packed into a 100 sq ft house. Health suffers in such cramped situations,” he observes.

Dr Merchant also points to the endemic problems faced by the Kumbharwada community of potters who live amongst their kilns. Asthma and tuberculosis has been seen in many of them and there are frequent complaints of lung ailments. “I have seen small children use nebulizers here. The government needs to look into these issues and, rather than move them away, needs to consider more tactful means to help the community use its kilns and simultaneously take care of their health.”

At one time Dharavi was infamous for its profusion of illegal country-liquor shops. While the liquor shops have now been pushed into more unmonitored areas, drug use is a major problem, says Dr Merchant. Several teenagers are involved in drug use and drug-related crime, and it is usually their parents who bring them to the clinic. But rehab is an expensive, long-term proposition that most families give up on at a certain a point.

Dr Merchant says that women who come to his clinic are often suffering from a common ailment he calls “male-dominated society.” Some women are pregnant with their fourth child, some are anaemic from fasting, and some cook four times a day for the whole family, but pay no attention to their own nutritional needs.

On most days Dr Merchant has no time to even sit down in his clinic, and says that he often doesn’t tell people where it is. He gives them locations in the vicinity, such as Matunga Labour Camp or Sion, because people tend to raise an eyebrow if he says he works in Dharavi. Nevertheless, clients seek him out from as far away as Virar and Thane. His family lives abroad, but he says he will continue working in his small Dharavi clinic as long as he can. “I cannot imagine a day when I am not working here,” he says, as patients line up outside.

On the road with 13-year-old Farida and her best friend Ayesha. We are on our way to finish off a film shoot. Hungry and sweaty under the afternoon sun, but not wanting to waste time, we buy ourselves a pack of choco-chip biscuits, the name of which I have never heard before.

After munching the biscuits, and dropping a few on the way, we are obviously thirsty. Farida suggests that we grab some roadside vendor’s lime juice for Rs. 5. She vouches not only for its refreshing taste, but makes it sound like some elixir of immortality. I stoutly refuse to swim in unknown waters, but since the girls seem keen on lime juice I consider going to a restaurant. The only restaurant in the vicinity is unfortunately attached to a bar, and it seems properly improper to take young girls to a place where men might be mixing desi mojitos. We finally settle for a healthy option: tender coconut water.

Three of us share two coconuts. 10-year-old Ayesha refuses to have one for herself. Though it is technically my treat, the shy girl hesitates on hearing the price. One coconut for Rs. 30 is just too much. She says that her mother would never allow her to spend that much money on a drink and continues to sip from Farida’s.

The elder Farida then tells us about some of the things she eats when she finishes school. Her mother gives her Rs. 10 every day and that, she says, is enough to quell her after-school hunger-pangs. For Rs. 5 she gets either a small apple or a custard apple from the fruit-seller (images of shrivelled up custard-apples come to my jaundiced mind). For the remaining Rs. 5 she gets a sumptuous slice of watermelon or her favourite lime juice. Seeing my raised eyebrow, she quickly rescues herself by lying, “But I prefer watermelon, of course.” As Farida breaks down the economics of her food expenditure, you realise that those ten rupees are husbanded carefully. She thinks her choices are more nutritious that what other kids might be buying. And sometimes a friend pitches in her pocket-money and the girls are able to buy something more substantial.

Ayesha, on the other hand, comes from more impoverished circumstances and does not have the luxury of Rs. 10 every day. Farida confesses that Ayesha is in fact recovering from dengue, but her mother finds buying the medicines too expensive.

At the end of the shoot, I treat the girls to some chocolates. Ayesha didn’t want a Rs. 10 chocolate. She wanted one for just half that price.

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A 2006 UNDP Human Development Report made an almost unbelievable estimate of one toilet for every 1440 people in Dharavi. It went on to describe the situation: “In the rainy season, streets, lacking drainage, become channels for filthy water carrying human excrement.” “People in Dharavi rely on wells, tankers or unsafe sources for their drinking water. In a typical case, 15 families share one tap that works for two hours a day.” If reports are not enough, there was the 2008 flim Slumdog Millionaires’s exaggerated graphic depiction of the boy-jumping-into-a-shit-hole scene in Dharavi.

Toilets, sanitation and the recent rise in reported rape cases across the nation that coincide with this lack of toilet facilities, made us want to get some insider stories through candid conversations with Dharavi Biennale participants. Anjali Amma, around 55 years old, lives in Pila Bangla in a house right next to a common toilet block. Her son got married earlier this year and she was worried about wedding guests commenting on the mucky state of the toilets. Unable to bear the stench, she decided to do her part by cleaning them herself. “Everybody praises me for it, but no one comes forward to clean the toilets. I couldn’t dream of my son’s wedding taking place without a clean loo next door,” she says.

The state of disrepair of common toilet units is a familiar story. While the adjectives describing them are unpleasant to the senses, the list of problems is specific: lack of water supply, safety hazards for women and children, poor maintenance and lack of a sense of sanitation. The overarching problem seems to be that there are very few toilets in working condition and many people who need them.

Moreover, what are the choices that Dharavi people make? The desire to reside in a central location of Mumbai like Dharavi has overpowered the necessity to leave room to build more toilets. The choice residents make is to stand in long queues rather than relinquish their home space. It raises a debatable question on urban health on which is a more serious predicament: living in dingy small spaces that breed diseases or using badly maintained common toilet blocks.

If the authorities do not do their part to keep the toilets clean, residents like Anjali Amma have taken matters into their own hands. She and her neighbours each put in Rs. 30 every month (one rupee per day) and take turns to clean the toilets themselves. She has even taken the initiative of making a lock for the toilets so those with no interest in paying up do not misuse them. Unfortunately they keep breaking the locks, she says.

Malati Murkar, a resident of New Kamala Nagar near the polluted Mithi river, says that she and her neighbours contributed Rs. 500 each some years ago so that they could have a common, exclusive toilet block. While they deal with the problem of broken locks, they still manage to maintain the sanitation. “We take water and bleaching powder from home every weekend and wash the toilet. Every lady who uses it washes it,” she says. One may wonder why the men in their families don’t help their wives, mothers, daughters and sisters, but Malati recalls that when her two sons were younger they would have to be careful venturing out at night to use the nearby toilet.

19 year old Saiba Kadir also hesitates to use common toilets and it is normal for women visit the toilets in groups. Her younger sister Fareeda, who is 13, says that she is unafraid, although she has heard of ‘bad things’ happening to girls who go to the toilets alone at night. She chuckles and says, “I travel all alone to my school in Bandra by train. I am usually the one who reassures my sister if we are ever alone in a place.”

Luckily, the long lines outside their local toilets mean that there are people around, even at midnight. Bhagyashree Alkunte, a friend and neighbour, says that so many people need to use them before and after dinner that four toilets can’t possibly meet the needs of the area. Saiba says that they have requested (she doesn’t know to whom) a toilet to be built above the gutters, but her family and neighbours are rethinking the idea because the gutters flood in the monsoons.

Another group of girls, who did not wish to be named, say that the visiting the toilets in the wee hours of the morning is a golden opportunity for them for some girl-talk. Living in mostly one-room houses where privacy is hard to come by, stepping out to use the toilets is a good excuse to share the latest neighbourhood gossip on lovers and relationships and nagging in-laws. One girl says that she takes her mobile phone with her and makes a quick good morning call to her boyfriend in the privacy of the loo.

Sitaram Kharat, Dharavi Biennale’s logistician, feels that private-public partnerships may be the way to go for improved and safe sanitation services. In his locality, Naik Nagar, an NGO named SPARC teamed up with the MHADA some years ago to set up three well maintained block of toilets that are rumoured to be some of the best in Dharavi. Each block has about 22 toilets with regular water supply. “Back in the 1990’s, people in my locality used the BMC’s open maidan as a toilet. When the BMC stationed a construction company’s on-site office in the maidan, that is when the need for an actual toilet arose. Before that, could you believe that people in my locality didn’t actually use a toilet?” he wonders.

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There is a dimly-lit community centre with two rooms at Kumbharwada, Dharavi. You reach it after treading clayey paths where workers labour over sacks of mud meant for the potter community. One room is for visits from an allopathy doctor and in the other is a homeopath. No signs advertise the services available at the community centre, but there is a steady trickle of patients, mostly elderly. They enter in a moment of suspense: which door will they choose? Allopathy or homeopathy?

The clinics are part of a charitable trust, the Pramila and Harishkumar Foundation, set up by homeopath Dr Geeta Punjabi in 2009. The 74-year-old veteran meant them to cater for the poor in Dharavi so that they could get quick relief at subsidised rates. The homeopathy centre is currently attended by Dr Poonam Talreja, who has been there since 2010. Her clinic is painted a bright shade of green and most of the space is taken up by trays of bottles of homeopathic medicines. It’s hard to find her unoccupied. As each patient consults her, the conversation is punctuated by the pitter-patter of raindrops on the asbestos roof. The patients queueing outside grumble impatiently in low voices, but are glad that the doctor gives each of them a decent amount of time.

Dr Talreja says that she has seen some challenging cases cured with homeopathy. “We don’t try to heal just a particular organ, but rather improve the overall immunity of the patient. We won’t claim that all our patients have reached normalcy, but they have surely reached a near-normal state,” says Dr. Talreja.

Sometimes mistaken for a “lady-doctor,” she points out that the commonest health issues she sees in Dharavi are chronic fatigue, joint pains and asthma attacks. “These are mostly female patients. They neglect their health and they hope that if they pop a pill they’ll be fine instantly,” she says, nodding her head. Most of her female patients are daily wage-earners and she says that a quick fix is a must or it could mean losing out on a day’s pay. People also come with digestion problems. “Many Dharavi people have problems such as constipation or diarrhoea, but I am careful before prescribing medicines. I always check to make sure that they have toilets in the vicinity of their homes. Otherwise, it could be a big problem for a patient who has just taken some laxatives.”

With subsidised rates for medicines (globules are free, tinctures and laxatives are half-price), Dr Talreja says that not everyone is Dharavi is poor. There is a donation box in the clinic and more affluent clients are advised to purchase the medicines at retail rates.

When clients enter the community centre, which door do they choose? Have they made an informed decision about which medical recourse will work best for their health issues? Or do they try both allopathy and homeopathy with the hope that something might eventually work?

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We are roaming the lanes of Dharavi with a mission to shoot at sight. We are on the lookout for signboards on health (normal, quirky, spelt wrongly – all kinds) as part of our latest workshop by Khushboo Bharti. We are studying the various design aspects of health signboards in the area and understanding the impact on locals. We have broken up into groups and the naughtier boys have obviously chosen to go the farther ends of Dharavi with the hope of playing truant.

Some of our girls and we are walking on the crowded 90 Feet Road when we see a shop with a very interesting copy. It is a weight loss-weight gain clinic and it read, “Health, Wealth and Happiness Clinic”. There is a sly subheading with an announcement in Indian English stating, “One visit may change your life 100%”. We wonder what kind of clientèle this centre might be having. Will the ordinary Dharavi resident be willing to spend at this centre for weight issues or will she be more open to home remedies and neighbourly advice? And are body image issues only a concern for the privileged?

Centres like this mark a change in the wellness options for people in Dharavi and the kind of advertising measures they undertake. If you thought the handpainted signboards are the norm in Dharavi, well, you will be mistaken. They are on the verge of extinction here as much as in the rest of Mumbai.

We spot a few of these handpainted signboards such as that of the Bharat Mata Health Club, a very stylish way of referring to a gym. These health clubs were places for bodybuilding and that gave you the hope that you could become a pehalwan (bodybuilder) of legend. Bodybuilding is of course an art in the Indian tradition, with several cultural and dietary practices that surround it.

Some signboards in Dharavi have copies in a variety of languages apart from English and Hindi. There are pockets of Maharashtrians, Tamilians, Muslims and Andhra Pradesh people in Dharavi and you can even tell where they are located by looking at the languages on a signboard. In fact some of these signboards are congested with several fonts, scripts and colours that they send you into a psychedelic dizzy.

Another group notes that there are several dental clinics in the area and you can identify those by the ubiquitous symbol of the tooth. Graphic literacy and constant repetition of the sign makes sure that people know what a smiling tooth or a happy tooth refers to. Our mentor artist Khushboo Bharti wonders if the huge number of dental clinics in Dharavi indicates dental health as a major concern among residents here.